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A New Bone-Ligament-Bone Autograft From the Plantar Plates of the Toes and Its Potential Use in Scapholunate Reconstruction: An Anatomical Study

Müller, Miriam MD; Reik, Milena; Sauerbier, Michael MD, PhD; Germann, Günter MD, PhD

doi: 10.1097/SAP.0b013e3181631b3f

The study was performed to investigate a new bone-ligament-bone autograft from the plantar plate of the toes. The anatomic properties of the plantar ligaments and the technical feasibility to harvest a bone-ligament-bone graft were examined to evaluate the potential use of this graft for a suitable reconstruction of the scapholunate (SL) interosseous ligament.

The plantar plate of the metatarsophalangeal joints of the second to fifth toe and the proximal interphalangeal joints of the second to fourth toe were examined in 20 cadaver feet (15 fresh and 5 embalmed cadavers) and measurements such as length, thickness, and width were taken.

The average length of the plantar ligaments of the proximal interphalangeal joint was 0.63 cm (D3) and 0.62 cm (D4). The length of the plantar plates of the proximal interphalangeal joint of the third and fourth toe was found to be similar to that of the SL ligament. In addition to the measurements, a bone-ligament-bone autograft of the plantar plates of the metatarsophalangeal joint was designed as an SL-ligament substitute and successfully transplanted into cadaveric wrists. This new autograft is intercalated between the scaphoid and lunate and, contrary to all previous methods, not simply superimposed upon them.

Length of the plantar plates was considered by the authors as the main criteria for selection of the new bone-ligament-bone graft. The plantar plate of the proximal interphalangeal joint of the third and fourth toe showed a similar length compared with the SL ligament. Therefore, it can be concluded from the data that this bone-ligament-bone graft can be a suitable replacement for the SL ligament.

From the Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic and Hand Surgery of the University of Heidelberg, Ludwigshafen, Germany.

Received August 22, 2007, and accepted for publication, after revision, November 25, 2007.

Reprints: Günter Germann, BG Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.